AbstractObjective To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer. Methods Clinical data of 11 patients with inoperable locally advanced rectal cancer, 7 male and 4 female, admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed. All patients received pelvic external irradiation (50 Gy in 25 fractions), followed by a three-dimensional intracavitary brachytherapy boost (15-20 Gy in 3-4 fractions,1 fraction/week). External beam radiotherapy was used to boost the dose to the perirectal lymph nodes (60-66 Gy in 30-33 fractions). All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy. Efficacy evaluation was performed using the RECIST standard. Survival and local control rates were calculated using the Kaplan-Meier method. Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria. Results The CTV D90% EQD2 Gy of HDR 3D-ICBT among 11 patients was (21.3±1.60) Gy. The complete response (CR) and partial response (PR) rates were 64% and 27%,respectively, yielding an objective response rate (CR+PR) of 91%. With a median follow-up time of 36 months, the 1-,2-,and 3-year overall survival rates were 82%,64% and 46%,respectively. The 1-,2-,3-year disease-free survival rates were 64%,45% and 27%,respectively. The 3-year local control rate was 46%. One patient presented with lung metastases after 8 months, 7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions, only one patient had grade 2 myelosuppression;long-term grade 1-2 intestinal reactions occurred in 5 patients, and 1 patient had long-term grade 1-2 bladder reaction. All the radiation-induced toxicities were alleviated by medication administration. Conclusions External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer,which yields reliable clinical efficacy and tolerable adverse reactions.
Fund:National Natural Science Foundation of China (31600679);Project of Science and Technology Department of Jilin Province (20190303151SF);Bethune Special Research of Science and Technology Department of Jilin Province (20160101079JC);Horizontal Project of Jilin University (2019220101000327)
Zhao Zhipeng,Li Dan,Guan Wei et al. Preliminary observation of the results of external irradiation combined with brachytherapy for inoperable locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 437-440.
Zhao Zhipeng,Li Dan,Guan Wei et al. Preliminary observation of the results of external irradiation combined with brachytherapy for inoperable locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 437-440.
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